INTRODUCTION:Atrial fibrosis is an adverse factor for arrhythmia recurrences and thromboembolic events in atrial fibrillation (AF). Cardiac magnetic resonance imaging (CMRi) has emerged as a noninvasive tool for its assessment, though evidence remains conflicting. METHODS AND RESULTS:Sixty ablation-naïve patients with AF scheduled for first-time catheter ablation were enrolled (78% men, 67% paroxysmal AF, 73% heart failure reduced ejection fraction [HFrEF]). Prior to the procedure, CMRi was performed in sinus rhythm (SR) on a 1.5T system using a high-resolution (1.3 mm isotropic) free-breathing 3D LGE sequence with echo-navigator end-expiratory gating and whole-heart coverage. Left atrium (LA) fibrosis was quantified using the commercially available ADAS 3D software, with fibrosis defined at four image intensity ratios (IIR) thresholds (0.97, 1.2, 1.32, and 1.61 times mean blood-pool signal intensity). High-density electroanatomical mapping (EAM) was performed in SR, and low-voltage substrates (LVS) were quantified at three bipolar voltage thresholds (0.5, 0.25, and 0.1 mV). LVS-EAM were identified in 97%, 88%, and 45% of patients at 0.5, 0.25, and 0.1 mV, respectively. LGE-CMRi was detected in 100%, 97%, 63%, and 17% of patients at IIR thresholds of 0.97, 1.2, 1.32, and 1.61, respectively. Quantitative correlation between CMR- and EAM-derived fibrosis was negligible to weak across all threshold combinations. When fibrosis was analyzed dichotomously, agreement was highest between EAM 0.5 mV and CMR IIR 0.97 (0.97, 95% CI [0.92, 1.00]; p < 0.001) and IIR 1.2 (1, 95% CI [1.00, 1.00]; p < 0.001), and between EAM 0.25 mV and CMR IIR 0.97 (0.87 95% CI [0.76, 0.97]; p < 0.001) and IIR 1.2 (0.9, 95% CI [0.81, 0.99]; p < 0.001). CONCLUSIONS:In an ablation-naïve AF population with a predominance of HFrEF patients, CMR- and EAM-derived measures of atrial fibrosis showed poor quantitative correlation across multiple threshold combinations. Although agreement improved when fibrosis was analyzed dichotomously (presence vs. absence of fibrosis), the highest agreement was observed at the most sensitive threshold combinations. The findings of our study highlight the need for standardized, validated, and reproducible CMR protocols for native atrial fibrosis assessment in order to provide a noninvasive alternative to EAM.

Carotid intima-media thickness (cIMT), amyloid-β1-40 (Aβ1-40), and oxidative stress are markers of vascular aging and cardiovascular risk. We compared the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), and their combination on the aforementioned markers in type 2 diabetes (T2DM). We prospectively studied 183 metformin-treated T2DM patients, propensity-score-matched to 12-mo treatment with insulin, liraglutide, empagliflozin, or liraglutide plus empagliflozin. Six-segment cIMT and plaque-equivalent lesions (cIMT ≥ 1.5 mm) were assessed at baseline, 6, and 12 mo; plasma Aβ1-40 and malondialdehyde (MDA) were measured. All regimens were associated with reductions in cIMT and Aβ1-40 at 12 mo (P < 0.05). MDA decreased overall with the largest reduction in GLP-1RA-based regimens. Compared with insulin, liraglutide, empagliflozin, and their combination achieved greater reductions in cIMT (-8.2, -5.6, and -10.7% vs. -1.7%, P < 0.05) and in Aβ1-40 (-52.1, -40.3, and -50.7% vs. -30.7%, P < 0.05). Patients achieving cIMT < 1.5 mm at 12 mo was the highest with combination therapy (75%), followed by liraglutide (67%) and empagliflozin (54%) versus insulin (40%; P < 0.05). Patients who regressed <1.5 mm showed greater reduction in Aβ1-40 than those with ≥1.5 mm (-56.2% vs. -25.1%, P = 0.028). Liraglutide, empagliflozin, and their combination induced greater reduction of cIMT (-8.2, -5.6, and -10.7% vs. -1.7%) and Aβ1-40 (-52.1, -40.3, and -50.7% vs. -30.7%; P < 0.05) compared with insulin. cIMT regression was associated with Aβ1-40 and MDA reductions (P < 0.05). In T2DM patients, GLP-1RA and SGLT-2i-particularly in combination-were associated with improvements in carotid atherosclerotic burden, amyloid-related vascular injury, and oxidative stress.NEW & NOTEWORTHY We investigated the effect of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), and their combination on carotid intima-media thickness (cIMT) and amyloid-β1-40 (Aβ1-40) in diabetes. Twelve-month treatment with GLP-1RA, SGLT-2i, and their combination confers significant reductions in cIMT and Aβ1-40 compared with insulin. cIMT regression was associated with Aβ1-40 and malondialdehyde reductions. Our findings support that newer antidiabetic agents can favorably modify structural and biochemical markers of atherosclerosis.

We investigated potential differences in arterial stiffness, thickness of endothelial glycocalyx, deformation of left atrium and ventricle among various ischemic stroke subtypes and controls.We included 194 ischemic stroke patients (n = 47 lacunar stroke, n = 50 large artery atherosclerotic stroke [LAA], n = 49 cardioembolic stroke, n = 48 with embolic stroke of undetermined source [ESUS]) and 50 matched controls. We measured: (1) perfused boundary region (PBR4-25) of the sublingual microvessels, (marker of endothelial glycocalyx integrity), (2) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (3) left ventricular global longitudinal strain, left atrial (LA) reservoir, conduction and contraction strain, (4) myocardial work indices, by pressure-myocardial loops, and (5) PWV/GLS ratio, to assess ventriculoarterial interaction.Compared with controls, stroke patients displayed affected LA strains, LVGLS, Wasted Work, PBR4-25, cSBP, PWV, and PWV/GLS (p < 0.05). We observed differences in LA strain, PWV, PWV/GLS, and PBR4-25 between different ischemic stroke subtypes (p < 0.05). Participants with lacunar strokes had the most impaired PBR4-25, participants with cardioembolic stroke and ESUS had the most impaired LA strain, and LAA had the most affected PWV and PWV/GLS (p < 0.05). PBR4-25 value of 2.29 μm could discriminate lacunar strokes (AUC: 0.81, 95% CI: 0.74-0.89; p < 0.001), PWV cut-off of 13 m/second could discriminate LAA (AUC: 0.80, 95% CI: 0.72-0.89; p < 0.001) and LA reservoir strain cut-off of 25% could discriminate ESUS/Cardioembolic strokes (AUC: 0.78, 95% CI: 0.71-0.85; p < 0.001).Lacunar strokes exert excessive shedding of endothelial glycocalyx, LAA show aggravated aortic stiffness, while ESUS/Cardioembolic strokes demonstrate worse LA performance. These differences in the underlying pathophysiological mechanisms among stroke subtypes may guide individualized secondary prevention strategies.

Autoimmune rheumatic diseases (ARDs) are characterized by excessive immune system dysregulation and a significant inflammatory milieu that provokes multiorgan damage. Inflammation holds a key role in the pathophysiology of cardiovascular disease (CVD), thereby explaining the increased cardiovascular risk of patients with ARDs. Among all cardiovascular risk factors, hypertension is the most prevalent one in patients with ARDs. The pathogenesis of hypertension in ARDs is multifactorial and the result of a complex interplay between several traditional cardiovascular risk factors, the sympathetic nervous system, autoimmune disease specific factors and genetic predisposition. Importantly, even though patients with ARDs and hypertension suffer a markedly increased cardiovascular risk, current guidelines lack a widely accepted risk prediction tool to accurately estimate CVD risk and provide a highly individualized approach. This review aims to analyse the prevalence and pathophysiology of hypertension in patients with ARDs and provide an overview of cardiovascular risk assessment in this high-risk group.

Background and Objectives: Patients with type 2 diabetes mellitus (T2DM) and ischemic stroke present with endothelial, vascular and left ventricular (LV) myocardial dysfunction. We investigated the effects of treatment with either glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium-glucose contrasporter-2 inhibitors (SGLT-2i) on endothelial glycocalyx, arterial stiffness, and LV myocardial strain in patients with metformin-treated T2DM and a prior ischemic stroke. Materials and Methods: A total of 54 consecutive patients with T2DM and ischemic stroke who attended a cardiometabolic outpatient clinic in Athens, Greece, and received either GLP-1RA (dulaglutide; n = 27) or SGLT-2i (empagliflozin; n = 27) were enrolled in the study. We measured the perfused boundary region (PBR) of the sublingual microvessels, a marker of glycocalyx thickness, as well as carotid-femoral pulse wave velocity (PWV) and LV global longitudinal strain (GLS), at baseline and at 4 and 12 months of treatment. Results: Twelve months after treatment, all patients had reduced glycosylated hemoglobin and body mass index (BMI) (p < 0.001). Patients treated with dulaglutide showed a greater reduction in BMI (-11.8% vs. -4.8%, p < 0.001) compared to those treated with empagliflozin. Compared to baseline, all patients had reduced PBR, PWV and GLS (p < 0.001) after 12 months of treatment. However, empagliflozin presented a greater decrease in PWV (-14% vs. -10.9%, p = 0.041), while dulaglutide resulted in a greater increase in GLS (14.7% vs. 8.3%, p = 0.024) compared to empagliflozin. In all patients, the reduction in PBR at 12 months was correlated with a decrease in PWV and with an increase in GLS (p < 0.05). Conclusions: Both dulaglutide and empagliflozin improve cardiovascular function in T2DM patients with ischemic stroke. Dulaglutide appears to be more effective in the improvement of LV myocardial strain, whereas empagliflozin is more effective in reducing arterial stiffness.

Coronary flow reserve (CFR) is a fundamental physiological index defined as the ratio of maximal coronary blood flow during hyperemia to resting flow. It provides an integrated assessment of the entire coronary circulation, from epicardial arteries to the microvasculature. Non-invasive assessment, particularly with transthoracic Doppler echocardiography (TTDE), is valuable in clinical practice for evaluating the functional impact of moderate obstructive lesions and determining the status of coronary microcirculation. Impairment of coronary microcirculation, detected by reduced CFR, is present in diverse conditions such as Tako-Tsubo cardiomyopathy, cardiac syndrome X, hypertension, and slow coronary flow. CFR also serves as a non-invasive tool to examine the effects of various interventions. CFR can be assessed invasively using Doppler guidewire or thermodilution techniques and non-invasively using transthoracic Doppler echocardiography, PET, CMR, CT perfusion, and dynamic SPECT. Lower CFR is observed with advancing age, in females, and in individuals of African descent. An impaired CFR is a powerful, independent predictor of major adverse cardiovascular events (MACEs) across a wide spectrum of diseases, including stable obstructive coronary artery disease (CAD), ischemic syndromes with no obstructive coronary arteries (INOCAs), heart failure, cardiomyopathies, and systemic diseases like diabetes and chronic kidney disease. Beyond risk stratification, CFR is used to guide therapeutic decisions, including revascularization strategies and tailoring of pharmacological interventions. The integration of CFR assessment into clinical practice, supported by recent guideline recommendations, represents a shift towards personalized, physiology-based cardiovascular care.

Aims:We investigated whether the early favourable effects of combined GLP-1 receptor agonist (GLP-1RA) and SGLT2 inhibitor (SGLT2i) therapy in left ventricular deformation is associated with long-term cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). We also addressed the healthcare costs. Methods and results:We enrolled 336 consecutive participants with T2DM, aged 60 ± 10 years old, 252/336 (75%) were males and were categorized into four groups: insulin, liraglutide, empagliflozin, and liraglutide+ empagliflozin. We measured at baseline and at 6 months left ventricular global longitudinal strain (LVGLS) via echocardiography. Patients were followed for 6 years and we recorded the incidence of composite endpoint of non-fatal cardiovascular events (myocardial infarction, heart failure hospitalization, ischaemic stroke, and coronary revascularization). Multivariable Cox regression models were built to assess associations between treatment groups, LVGLS changes, and outcomes. A cost analysis was also conducted. At 6 months LVGLS increased significantly (P = 0.020), with the greatest improvement observed in the combination group compared with insulin, GLP-1RA, and SGLT2i groups (P < 0.05). At 6-year follow-up, 91 events were recorded. Combination therapy was associated with the lowest risk of events (insulin vs. combination: HR = 4.36, 95% CI: 2.04-9.33, P < 0.001; GLP1-RA vs. combination: HR = 2.45, 95% CI: 1.06-5.64, P = 0.035; SGLT2i vs. combination: HR = 3.07, 95% CI: 1.38-6.81, P = 0.006). In combination group, improvement of LVGLS independently predicted reduced event risk (HR = 0.89, 95% CI: 0.79-0.98, P = 0.040). Combination group demonstrated the lowest mean cost per patient per month (insulin: 691€, 95% CI: 472-911; GLP1-RA: 224€, 95% CI: 44-404; SGLT2i: 528€, 95% CI: 305-751; Combination: 175€, 95% CI: 30-321). Conclusion:Combined GLP-1RA and SGLT2i therapy is associated with early improvement in myocardial deformation, which translates into reduced long-term cardiovascular risk and favourable economic outcomes. ClinicalTrials.gov Identifier: NCT03878706.

Vascular aging is a key determinant of cardiovascular risk and is characterized by endothelial dysfunction, oxidative stress, inflammation, arterial stiffness, and alterations of the endothelial glycocalyx. In recent years, increasing scientific interest has focused on whether selected nutritional supplements can modulate these mechanisms. The objective of this narrative review is to summarize and critically evaluate the current evidence regarding the effects of selected nutritional supplements on endothelial function and vascular health, with emphasis on their proposed mechanisms of action, available preclinical and clinical evidence, and current limitations. This review examines nutritional supplements targeting nitric oxide biology (L-arginine/L-citrulline and citrulline derived from watermelon), polyphenol-rich foods and extracts (cocoa flavan-3-ols and grape polyphenols), mitochondrial redox balance (coenzyme Q10 and the mitochondria-targeted antioxidant MitoQ), endothelial glycocalyx-supporting formulations, olive-derived bioactive compounds, curcumin, and S-allyl cysteine. Across studies, improvements have been reported primarily in surrogate vascular endpoints, including flow-mediated dilation, pulse wave velocity, and blood pressure, although effect sizes vary and substantial heterogeneity exists among studies. Overall, current evidence suggests that several nutritional supplements may improve surrogate markers of vascular function; however, evidence demonstrating reductions in major cardiovascular events or cardiovascular mortality remains limited. Future research should prioritize adequately powered randomized controlled trials with longer follow-up, standardized supplement formulations, and clinically meaningful cardiovascular outcomes to more clearly define the role of nutritional supplements in cardiovascular prevention.

Objective: Endovascular aneurysm repair (EVAR) constitutes the cornerstone of contemporary abdominal aortic aneurysm (AAA) treatment, owing to superior short-term outcomes in comparison with open surgical repair (OSR). However, this difference is offset by unfavorable long-term outcomes. EVAR may detrimentally affect aortic compliance, with significant subsequent consequences. We sought to elucidate the natural history of this phenomenon. Methods: We conducted a nonrandomized, prospective study of 140 consecutive patients undergoing elective EVAR or OSR for abdominal aortic aneurysm. Aortic stiffness was measured preoperatively (T0), within 1 week of the operation (T1), 4 to 6 weeks (T2), and at 1 year (T3), using a validated noninvasive device (Vicorder) to measure carotid-femoral pulse wave velocity (cfPWV) and brachial-femoral pulse wave velocity (bfPWV), as well as central pulse pressure. Repeated measures analysis of variance was applied to the hemodynamic measurements to quantify changes along time. Results: Of 140 patients, 130 (93%) underwent EVAR. EVAR resulted in a significant increase in carotid-femoral pulse wave velocity (T0, 9.9 +/- 1.3 m/s; T1, 11.0 +/- 1.6 m/s; T2, 12.2 +/- 3.8 m/s; and T3, 12.5 +/- 2.6 m/s; P < .05 for the comparison with T0), bfPWV (T0, 34.6 +/- 12 mm Hg; T1, 40.4 +/- 12.4 mm Hg; T2, 44.2 +/- 14.6 mm Hg; and T3, 44.3 +/- 12.6 mm Hg; P < .05 for the comparison with T0), and central pulse pressure (T0, 59 +/- 12 mm Hg; T1, 61 +/- 12 mm Hg; T2, 63 +/- 13; and T3, 64 +/- 12 mm Hg mm Hg; P < .05 for the comparison of T2 and T3 with T0). There were no significant differences across all timepoints for those having OSR. Conclusions: In this study, the first to use bfPWV in this context, EVAR, but not OSR, significantly decreased aortic compliance, not only immediately post intervention, but steadily over 1 year.

Aim: To investigate the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on cardiovascular function and hepatic metabolism in patients with type 2 diabetes mellitus (T2DM) and metabolic-dysfunction associated steatotic liver disease (MASLD). Methods: This is an unblinded real-world study using propensity score analysis of consecutive patients with T2DM and MASLD received either SGLT-2i (dapagliflozin; n = 21), GLP-1RA (dulaglutide; n = 21), or dipeptidyl peptidase-4 inhibitors (DPP-4i; n = 20). At baseline and after 12 months, we assessed the perfused boundary region (PBR) as a marker of glycocalyx thickness, peripheral and central systolic blood pressure (cSBP), pulse wave velocity (PWV), coronary flow reserve (CFR), left ventricular global longitudinal strain (GLS), controlled attenuation parameter (CAP), and liver stiffness (E). Results: At 12 months, all patients had reduced glycosylated hemoglobin and body mass index compared to baseline ( P < 0.001), as well as a significant reduction in cSBP, PBR, PWV, CAP, E, and increase in CFR and GLS ( P < 0.01). The percentage decrease in peripheral and central SBP was related with the improvement in PBR, PWV, CFR, and GLS at 12 months ( P < 0.01). Dulaglutide showed greater improvement in GLS (22.6% vs. 8.5%, vs. 5.9%, P = 0.015) and PBR ( P = 0.037) than dapagliflozin and DDP-4i. Both dulaglutide and dapagliflozin showed a greater increase in CFR than DDP-4i post-treatment. The percentage reduction in CAP was associated with the decrease in PBR, PWV and with the increase in GLS ( P < 0.05). Conclusion: Twelve-month treatment with either SGLT-2i or GLP-1RA improves central hemodynamics, coronary flow and reduces hepatic steatosis in T2DM individuals with MASLD.

OBJECTIVE:Patients with type 1 diabetes (T1D) present early subclinical signs of vascular and endothelial dysfunction. Hybrid closed-loop systems (HCLSs) are the gold standard for glycemic management; however, their cardiovascular benefits remain unclear. The aim of this study is to determine whether HCLS improves vascular and endothelial function compared with multiple daily injections (MDIs) or sodium glucose cotransporter 2 inhibitors (SGLT-2is) in T1D. RESEARCH DESIGN AND METHODS:Ninety consecutive patients with poorly controlled T1D under MDI treatment were categorized into three groups according to the treatment approach: (1) HCLS or (2) SGLT-2i added to MDI or (3) intensification of MDI treatment. We assessed at baseline and 6 and 12 months posttreatment: (1) continuous glucose monitoring metrics, (2) pulse wave velocity (PWV) and central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP) as markers of vascular function, and (3) the perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx integrity. RESULTS:At 6 months, HCLS demonstrated the most significant increase in time in range (TIR) followed by SGLT-2i (+28.61 vs +10.91, P = 0.026) compared with MDI group (+2.11, P < 0.001 for all comparisons). At 12 months, patients on HCLS showed a 2-fold and a 4-fold higher increase in TIR compared with SGLT-2i (P = 0.026) and MDI group (P < 0.001), respectively. At 12 months, HCLS and SGLT-2i group displayed the most significant decrease in PWV (-15.71% and -10.14%), cSBP (-8.15% and -6.88%), and PBR (-6.98% and -8.98%) compared with MDI (+5.67%, +1.49%, and +1.99%, respectively; P < 0.05). The absolute change of PWV, PBR, and cSBP was associated with the absolute change of TIR (P < 0.05). CONCLUSIONS:MiniMedTM 780G HCLS demonstrated superiority over MDI or SGLT-2i in terms of glycemic control and cardiovascular function in T1D. These results support HCLS as a preferred therapeutic option for the prevention of cardiometabolic disease in individuals with T1D, in a population whose cardiovascular burden is often underrecognized in both research and clinical practice.

Type 2 diabetes mellitus is a chronic metabolic disorder associated with microvascular and macrovascular complications. Hyperglycemia and insulin resistance are core pathophysiological components of diabetes, linked to subclinical inflammation and persistent oxidative stress, which result in endothelial dysfunction and subsequent atherogenesis. Nowadays, several arrows in the diabetologist's quiver are available for the management of diabetes, providing flexibility and the ability to adopt a personalized approach tailored to each patient's needs. Two of the most commonly prescribed antidiabetic drugs are sodium-glucose cotransporter 2 inhibitors and glucagon- like peptide-1 receptor agonists. Both agents are associated with beneficial metabolic, cardioand nephro-protective effects independent of their antidiabetic properties; thus, their indications have and are continuously expanding over and beyond the treatment of diabetes. Given that these two drug classes have different mechanisms of action, the use of their combination achieves a synergistic interaction and confers additional benefits. The aim of this review is to provide a summary of current knowledge regarding the use of these two drug classes, shed light on the available evidence on their combination, and discuss future perspectives on optimal therapeutic decisions in clinical practice. Sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in combination therapy are a promising therapeutic duo and are expected to influence future guidelines and decision-making in everyday clinical practice.

Clinical management of hypertension in patients with autoimmune rheumatic diseases (ARDs) is challenging. Firstly, the impact on blood pressure (BP) of several antirheumatic drugs varies and the available evidence points towards a wide range of effects. Secondly, management of hypertension in terms of diagnosis, BP thresholds and therapeutic targets currently follows the general recommendations, even though patients with ARDs present a markedly adverse cardiovascular profile. Thirdly, lifestyle interventions in terms of non-pharmaceutical management follow the general recommendations. Notably, it has been shown that they can improve autoimmune disease-specific endpoints, however, their intimate effect on BP has not been fully explored. Finally, the choice of anti-hypertensive medication currently complies with the general antihypertensive therapy recommendations, in the absence of appropriately designed studies in these populations. This review aims to summarize the impact of antirheumatic drugs on BP and present the available data regarding clinical management of hypertension in patients with ARDs.

Background/Objectives: Angiographic stenosis severity and functional significance are discordant in up to 65% of intermediate coronary lesions. Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has shown better clinical outcomes than standard angiography-guided PCI, therefore functional significance defines revascularization. This review evaluates the contemporary evidence for intracoronary physiology assessment tools, such as FFR, non-hyperemic pressure ratios (NHPRs), angiography-derived wire-free indices, and microvascular function testing, and proposes a framework for their implementation into clinical practice. Methods: We conducted a narrative review, synthesizing data from landmark randomized controlled trials (DEFER, FAME I–III, DANAMI-3-PRIMULTI, COMPARE-ACUTE, DEFINE-FLAIR, iFR-SWEDEHEART, iMODERN, FAVOR III China and Europe, FAST III, ALL-RISE, CorMicA), along with pooled analyses, meta-analyses, position papers, and relevant guidelines. Results: FFR-guided revascularization resulted in a 28% reduction in cardiac death or myocardial infarction in pooled analyses (HR 0.72, 95% CI 0.54–0.96). leading to a Class I, Level A indication. NHPRs, including iFR, achieved non-inferiority to the FFR at 1 year; however, a 5-year pooled meta-analysis raised concerns of increased all-cause mortality with iFR guidance compared to the FFR (HR 1.34, 95% CI 1.08–1.67). Approximately 20% of lesions show FFR–iFR discordance, driven by vessel-specific physiology and microvascular factors. Wire-free technologies yielded conflicting results: the FAVOR III China trial favored the QFR over angiography, yet FAVOR III Europe failed non-inferiority versus the FFR, while the recent FAST III and ALL-RISE trials demonstrated the non-inferiority of angiography-derived physiology at 1 year. Up to 40% of patients with angina have non-obstructed coronary arteries, and coronary vasomotor function testing can identify treatable microvascular endotypes improving symptoms and quality of life. Conclusions: Functional invasive coronary angiography is advocated to decipher vessel hemodynamics and to guide treatment. The FFR remains the gold standard for invasive physiological assessments, while NHPRs and wire-free technologies are valuable adjuncts with specific indications and limitations. A thorough microvascular evaluation is essential for differentiating between various INOCA endotypes and is gradually being adopted by the interventional community. While NHPRs and virtual technologies struggle to dethrone the king FFR, a comprehensive intracoronary physiology assessment is essential to guide treatment.

Patients with type 2 diabetes mellitus (T2DM) exhibit high morbidity and mortality despite research progress. The aim of this study was to assess the efficacy of multidisciplinary cardiometabolic outpatient clinics in medical treatment of T2DM outpatients. A prospective, cohort study of 200 T2DM patients attending cardiometabolic, tertiary, outpatient clinics of “Sotiria” Chest Disease Hospital and Attikon Hospital was conducted. Patients underwent structured clinical evaluation at each visit by both Diabetologists and Cardiologists including cardiovascular risk assessment, lifestyle change recommendations and optimization of medical treatment based on ESC Guidelines. Our population comprised by 76

Mitral regurgitation (MR) is a common valvular heart disease associated with significant morbidity and mortality. For patients at high or prohibitive surgical risk, mitral transcatheter edge-to-edge repair (M-TEER) offers a less invasive alternative to surgery. This review outlines key aspects of patient selection and procedural planning for M-TEER, with a focus on clinical and echocardiographic criteria essential for success. Comprehensive imaging—especially 2D and 3D transesophageal echocardiography—is critical to assess leaflet anatomy, coaptation geometry, and mitral valve area. Selection criteria differ between primary and secondary MR and are guided by trials such as COAPT and MITRA-FR. Optimal outcomes rely on careful screening, anatomical suitability, and multidisciplinary evaluation. With growing experience and advancing technology, M-TEER has become a transformative option for treating severe MR in non-surgical candidates.

Abstract Background/Aim HIV infection is related with cardiovascular adverse events. We investigated the effects of antiretroviral treatment in myocardial and vascular function of newly diagnosed patients with HIV. Patients and methods: A total of 70 newly diagnosed HIV patients were enrolled. Patients were randomized to 4 different treatments which were descovy plus resolsta (emtricitabine/ tenofovir alafenamide), tivicay plus descovy (tenofovir alafenamide/ emtricitabine), genvoya (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide) and descovy plus isentress (raltegravir). We measured at baseline and 12 months posttreatment: (a) Left Ventricular (LV) Global Longitudinal Strain (GLS), (b) LV Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE). At baseline, we compared the HIV patients with 35 healthy matched controls. Results At baseline patients with HIV had devastated myocardial function, endothelial function and endothelial glycocalyx compared with healthy controls. Twelve months after intervention HIV patients improved myocardial function, as assessed by GLS, GWI and GCW as well as endothelial function as evaluated by decrease of PBR5-25. Nevertheless, in HIV patients 12 months post treatment myocardial and endothelial function and endothelial glycocaylyx was impaired in comparison with healthy controls. Conclusions Treatment with antiretroviral therapy partially improves myocardial and arterial function 12 months post treatment.

Purpose: To examine the association between diabetic retinopathy (DR) and the atherosclerotic cardiovascular disease (ASCVD) risk score using the “ASCVD Risk Estimator Plus” tool in patients with type 2 diabetes mellitus (DM) and to assess risk factors potentially associated with DR. Methods: Participants in the study included 181 patients with type 2 DM who underwent a thorough ophthalmic examination, including a best-corrected visual acuity (BCVA) measurement, a dilated fundoscopy, fundus photography, an optical coherence tomography (OCT), and an OCT-angiography (OCT-A). DR was graded as no apparent retinopathy (NDR), mild non-proliferative (NPDR), moderate NPDR, severe NPDR, or proliferative DR (PDR). In addition, a detailed medical history of patients was recorded, while the “ASCVD Risk Estimator Plus” tool by the American College of Cardiology was used to calculate the ASCVD risk. Results: The ASCVD score, derived by the “ASCVD Risk Estimator Plus”, was not found to be significantly correlated with DR (p = 0.191). Multivariable logistic regression analysis showed that factors associated with DR independently included DM duration (multivariable OR = 3.16, 95% CI: 1.55–6.44, p = 0.002), HbA1c levels (multivariable OR = 2.94, 95% CI: 1.37–6.32, p = 0.006), and the presence of neuropathy (multivariable OR = 3.59, 95% CI: 1.43–9.05, p = 0.007). In the multivariable multinomial logistic regression analysis, NPDR development was associated with duration of DM (multivariable RR = 3.31, 95% CI: 1.57–6.97, p = 0.002), HbA1c levels (multivariable RR = 2.24, 95% CI: 1.00–5.02, p = 0.050), and neuropathy (multivariable RR: 3.94, 95% CI: 1.54–10.11, p = 0.004), while PDR development was only associated with HbA1c levels (multivariable RR = 6.88, 95% CI: 2.19–21.63, p = 0.001). Conclusions: The ASCVD score, as it was calculated using the “ASCVD Risk Estimator Plus” tool, was not found to be significantly associated with DR. Factors significantly associated with DR were DM duration, HbA1c levels, and the presence of neuropathy.

BACKGROUND AND AIMS:Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. METHODS:This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants-COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. RESULTS:2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2-4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2-4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID- group. CONCLUSIONS:COVID-19 is associated with early vascular ageing in the long term, especially in women.